Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection

Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection

Eriksen J et al Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection. Acta Anaesthesiol Scand. 2019 Feb;63(2):171-177

What is already known:

ERAS protocols have been safely implemented in colorectal surgery and include early mobilisation after surgery. Orthostatic hypotension (OH) and orthostatic intolerance (OI) are both barriers to full implementation of ERAS protocols post-operatively but their mechanism, risk factors and prevalence are not currently known. This study aimed to investigate these factors.

What this paper adds:

This single centre prospective observational study looked at 100 patients presenting for elective minimally invasive colorectal resections for underlying cancer. OI was present in 60% of patients in the first 24 hours postoperatively. Risk factors for development of OI at 6 hours were lower age, lower BMI and female gender. Female gender and ASA >1 were predictive of OI at 24 hours. There was no association between opioid consumption and fluid administration within the first 24 hours with the development of OI. There was a tendency for patients with OI at 24 hours to have a prolonged length of stay. This study further supports previous work showing that any barrier to adherence to the strict ERAS protocols can lead to delayed hospital discharge. Further studies should aim at looking at ways to minimise postoperative OI.

Katie Wimble, Guildford